Some pregnancy-prevention programs are 'tops' in their field. It's amazing how little such programmes deals with sex.

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The fascinating feature of a highly successful teen pregnancy-prevention program used in Roanoke, USA, high schools is how little it deals with sex and how much it deals with learning to feel good about yourself.

"It totally showed me how to work with people in the community and know where I stand with people," Korrine Dillard, 18, says of the Teen Outreach Program (TOP), part of a nationwide initiative. The program taught him to volunteer in a day-care centre.

Stacey, a 16-year-old who asked that her last name not be used, says, "I'm very good with children, and it was also fun working with the elderly." Her time in TOP was spent volunteering as a children's tutor and serving as a companion in a nursing home.

The fact that both students were sexually active before they participated in TOP and both are now abstinent - and plan to stay that way for a while - doesn't seem significant to them.

But it's very significant to health and education professionals involved in identifying successful teen pregnancy-prevention programs. "The Teen Outreach Program and other service-learning programs have among the strongest evidence of any pregnancy-prevention programs that they actually reduce teen pregnancy," says Doug Kirby.

Kirby is the author of an upcoming book that evaluates more than 75 teen pregnancy-prevention programs, including TOP, and identifies the most successful ones.

Says Korrine: "You learn to just respect yourself. The counsellors make you more aware of the STDs [sexually transmitted diseases] out there and that the safest way is to be abstinent." Adds Stacey, "I don't want a child because I'm not ready."

A recent study of approximately 600 teen-agers in 25 schools across the country found that female TOP participants were 41 percent less likely to become pregnant than girls in the same schools who weren't in the program, according to study author Susan Philliber, a senior partner in Philliber Research Associates, which evaluates human service programs. "A reduction of that magnitude is unprecedented in pregnancy prevention," she adds.

giving clear advice on healthy choices about sex, including abstinence as well as birth control;

providing well-trained teachers;

and teaching social skills to prepare the students for life after school. "The successful programs are all quite different, but they are all intensive and active," says Kirby, whose book, Emerging Answers, will be published in February by the non-profit, Washington D.C., USA-based National Campaign to Prevent Teen Pregnancy.

At TOP, which can be found in more than 45 schools in 15 states, the intensity and activity focus on teaching teens to be successful volunteers so they'll gain self-confidence and build self-esteem. This, in turn, will hopefully lead them away from dangerous sexual behaviour and early pregnancy, says Cheri Hartman, the director of TOP in Roanoke.

"Everything we do is grounded in promoting positive youth development by enhancing assets, not focusing on fixing deficits; getting rid of negative behaviour by strengthening positive behaviour," she says.

Philliber says, "Service learning has been shown to be a powerful tool in preventing teen pregnancy by exposing teens to the world of work, getting them out in the community and contributing and giving them personal satisfaction."

This encourages teens to become motivated and adopt adult goals that are incompatible with early pregnancies, she adds. "They know that a baby will ruin their lives," Philliber says.

In Roanoke, teens are selected for the program by criteria set up in each high school. Many are enrolled because their school has deemed them at high risk for pregnancy or dropping out of school, a determination based on poor grades, truancy or social problems in school.

Surprisingly, the program is also popular with good students who want to round out their resumes, Hartman says. During the last 10 years, TOP has served more than 1,000 Roanoke teens at four high schools, she says.

4 teens to 1 instructor

Teens are able to choose one activity from more than a dozen volunteer activities. They can range from reading stories to preschoolers, to working at an animal-adoption agency to building a computer from component parts.

The program is carefully orchestrated every step of the way, Hartman says, from helping students find a good mentor, to training them thoroughly so they're successful at what they do. A ratio of four teens to one instructor allows the professionals to work closely with each child. "The reason we can take high-risk teens is because it's so intensely supervised," Hartman says. "We don't want kids sitting in the corner watching - we want them to feel useful. We structure the program to maximize success."

TOP is designed to last for one year, with a minimum of 25 hours of volunteer work. The teens spend an equal number of hours in class, discussing their volunteerism and other topics dealing with social issues that sometimes, but not always, include sex.

"There's really a hullaballoo over sex education," Hartman says. Even though a little less than 15 percent of TOP's curriculum in Roanoke includes sex-education information, organizers make sure to get approval from the schools before they include it in the program, she says.

"You really have to be careful," Hartman says. Philliber says her study found that TOP programs that don't use the sex-education section still achieve the same results as those that do. "We had some sites that left the sex-education chapters out, but it didn't affect the outcome," she says. "The key part of the success is the volunteer work."

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